Cervicogenic Headaches

Question 1

Where do cervicogenic headaches usually start?

Answer 1

in occipital lobe and radiate unilaterally to head and face

Question 2

How many pts who suffer from cervicogenic headaches also complain of neck pain associated with their headache?

Answer 2

roughly 70%

Question 3

What is the anatomical basis for the cervicogenic pain pattern?

Answer 3

Trigeminocervical nucleus (afferents from CB V and Spinal nerves C1-C3 and nuclei of head, throat, and neck afferents)

Question 4

How does the frequency change between cervicogenic headaches, migraines, and tension-type headaches?

How does the duration change?

Answer 4

cervicogenic are chronic and episodic lasts between an hour and weeks

migraines are usually 1-4 times a month lasts 4-72 hrs.

tension-type can be 1-30 a month and can last days or weeks

Question 5

What are the possible signs of intracranial pathology for cervicogenic headaches?

Answer 5

• sudden onset of severe headache w/ increasing intensity
• persistently unilateral headaches
• headaches that wake the patient during the night or early morning
• generalized stiff neck or other signs of meningitis
• systemic symptoms (weight loss, fever, and malaise)
• focal neurologic symptoms or signs

Question 6

Roughly how many patients with headache or neck pain may have cervical artery dissection in progress? How many may be asymptomatic?

Answer 6

1 in 100,000

6% are asymptomatic, 80% head head and neck pain

Question 7

If a patient says they have pain in their neck and head that they have never felt anything like before what might you be concerned for? What are some major risk factors?

Answer 7

Screen for Atherosclerosis or potential arterial intimal damage (stroke risk)

-hypertension
-hyperlipidemia
-hypercholesteremia
-diabetes
-smoker
-BMI over 30
upper cervical instability

Question 8

What are the 5 D’s And 3 N’s (red flags) for cervical artery dysfunction?

Answer 8

Dizziness, Drop attacks, diplopia, dysarthria, dysphagia

Ataxia

Nausea
numbness
nystagmus

Question 9

What is the gold standard for diagnosing cervicogenic headaches? What are some setbacks for this method?

Answer 9

Diagnostic blocks (can abolish migraines for up to 30 days by blocking greater occipital nerve)

Lacks specificity and not feasible in outpatient settings

Question 10

What percentage of chronic headache patients have cervicogenic headaches?

Answer 10

10-15%

Question 11

What four things that can cause comparable symptoms of cervicogenic headaches should be screened for in the physical exam?

Answer 11

• Neck movement and/or sustained, awkward head -positioning
• external pressure over the upper cervical or occipital region (active trigger points)
• restriction of ROM and joint mobility in the neck (+cervical flexion-rotation test/abnormal joint mobility testing)
• poor deep cervical endurance (cranial cervical flexion test, neck flexor muscle endurance test)

Question 12

What constitutes a positive cervical flexion-rotation test?

Answer 12

less than 32 deg. or rotation after flexion

Question 13

What is the purpose of the cranial cervical flexor test?

What would a normal test result be?

Answer 13

assess deep cervical flexor strength

patient is able to generate 26-30 mmHg pressure for 10 seconds without compensations

Question 14

What is the purpose of the neck flexor muscle endurance test?

What is a normal test result?

Answer 14

asses deep cervical flexion strength

Over 38 seconds

Question 15

What 4 examination signs cluster can help rule in/out a diagnosis of cervicogenic headaches compared to migraine or tension type headaches?

Answer 15

• decreased AROM cervical extension
• palpably painful somewhere from OA to C3-C4 joint dysfunctions
• Deep cervical flexor strength impairments w/ cranio-cervical flexion test

Question 16

What examination diagnostic cluster used for female patients only uses 2 signs? What are the signs?

What other muscles were found to be significantly tighter in cervicogenic HA patients from this study?

Answer 16

Zito 2006 cluster

• palpably painful C1/2 joint dysfunctions
• pectoralis minor muscle length shortened

upper trap, levators, scalenes, SCM, pec major/minor

Question 17

What muscle activation was shown to be significantly greater in cervicogenic pts. when performing the cranio cervical flexion test?

Answer 17

superficial neck flexors

Question 18

True or False: evidence shows that spinal manipulation is effective in the short term treatment of cervicogenic HA when compared to massage or placebo spinal manipulation, and weaker evidence when compared to spinal mobilization.

Answer 18

True

Question 19

What interventions are indicated for acute cervicogenic patients?

Answer 19

clinicians should provide supervised instruction in active mobility exercise and provide C1-2 self-sustained natural apophyseal glide (self-SNAG) exercise

Question 20

What interventions are indicated for subacute cervicogenic patients?

Answer 20

clinicians should provide cervical manipulation and mobilization as well as provide C1-2 SNAG exercise

Question 21

What interventions are indicated for chronic cervicogenic patients?

Answer 21

clinicians should provide cervical or cervicothoracic manipulation or mobilization combined w/ shoulder girdle and neck stretching, strengthening, and endurance exercise

Question 22

What was the number needed to treat with Manual therapy plus exercise in order to see a 50% decrease in symptoms in patients that had headaches for over 6 years?

What was the number needed to treat in order to see a 100% decrease in symptoms?

Answer 22

2 for 50% reduction

3-4 for 100% reduction